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Dermatophyte infections
1Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina 29425, USA. hainerbl@musc.edu
Abstract:
Dermatophytes are fungi that require keratin for growth. These fungi can cause superficial infections of the skin, hair, and nails. Dermatophytes are spread by direct contact from other people (anthropophilic organisms), animals (zoophilic organisms), and soil (geophilic organisms), as well as indirectly from fomites. Dermatophyte infections can be readily diagnosed based on the history, physical examination, and potassium hydroxide (KOH) microscopy. Diagnosis occasionally requires Wood's lamp examination and fungal culture or histologic examination. Topical therapy is used for most dermatophyte infections. Cure rates are higher and treatment courses are shorter with topical fungicidal allylamines than with fungistatic azoles. Oral therapy is preferred for tinea capitis, tinea barbae, and onychomycosis. Orally administered griseofulvin remains the standard treatment for tinea capitis. Topical treatment of onychomycosis with ciclopirox nail lacquer has a low cure rate. For onychomycosis, "pulse" oral therapy with the newer imidazoles (itraconazole or fluconazole) or allylamines (terbinafine) is considerably less expensive than continuous treatment but has a somewhat lower mycologic cure rate. The diagnosis of onychomycosis should be confirmed by KOH microscopy, culture, or histologic examination before therapy is initiated, because of the expense, duration, and potential adverse effects of treatment.
Insights
Dermatophyte infections affect skin, hair, and nails. Topical allylamines offer higher cure rates than azoles, while oral treatments are best for severe cases like onychomycosis.
Area of Science:
- Medical Mycology
- Dermatology
- Infectious Diseases
Background:
- Dermatophytes are keratinophilic fungi causing superficial infections.
- Transmission occurs via direct contact, animals, soil, or fomites.
- Diagnosis relies on clinical presentation and microscopic methods.
Purpose of the Study:
- To review dermatophyte infections, diagnosis, and treatment options.
- To compare the efficacy of different therapeutic agents.
- To emphasize diagnostic confirmation before initiating treatment.
Main Methods:
- Review of existing literature on dermatophyte infections.
- Analysis of diagnostic techniques including KOH microscopy, Wood's lamp, and fungal culture.
- Evaluation of topical and oral treatment strategies.
Main Results:
- Topical allylamines demonstrate higher cure rates and shorter treatment durations than fungistatic azoles.
- Oral therapy is recommended for tinea capitis, tinea barbae, and onychomycosis.
- Pulse oral therapy for onychomycosis is cost-effective but may have lower mycologic cure rates.
Conclusions:
- Accurate diagnosis of dermatophyte infections is crucial for effective treatment.
- Treatment choice depends on infection site and severity, with topical allylamines and oral therapies showing promise.
- Confirmation of onychomycosis diagnosis is essential prior to treatment initiation due to cost and potential side effects.